| Here is a response from the President of the British Orthopaedic Association to the news that hip and knee replacements will be rationed in some areas of the country. Well said!
Many of you will have heard the discussion of CCG rationing on this morning’s ‘Today Programme’ (BBC Radio 4 at 07:50) here. You may be interested to read the follow up email below from the BOA President:
Dear Today Programme,
I listened with interest to your Interviews today on the subject of rationing by CCG’s of hip and knee replacements. It is unfortunate that a number of myths continue to be perpetuated in this debate which my colleague Steve Cannon had limited time to counter. As such I felt that it was appropriate to counter these in an email.
Firstly there is robust evidence that having a BMI between 30 and 40 does not increase your risk of a poor outcome following either hip or knee replacement. Indeed there is some evidence that this group of patients are actually the ‘happiest’ with their outcome. If your BMI is over 40 your complication risk goes up but if you have an uncomplicated outcome you are as happy with the outcome as thinner patients. A hip replacement costs £7.50 a week and 90% of hip replacements will still be in place having required no further treatment (beyond 15 years in many cases) when the patient dies. Patients prior to a major joint replacement will attend their GP’s on average a couple of times a month, post joint replacement a couple of times a year. The Oxford hip and knee scores were not designed as a pre-op screening tool they were designed as a tool to measure outcome. There is evidence that timely surgery has the best effect on the patient’s general health, the implication being that if their intervention is delayed their general health deteriorates. Using the well intentioned aim of a general improvement of the population’s general health as a justification for limiting access to very effective treatment is neither acceptable or ultimately cheaper. You wouldn’t ask a patient presenting with severe chest pain to go away and lose a couple of stone before you treat their coronary artery disease.
In an era where patients should be fully advised as to their options and then choose which treatment they have, this stance will inevitably lead to endless appeals and a further waste of resources to deal with them.
Kind regards
Ian Winson FRCS
BOA President |
